Mortgage Payment Protection Insurance

Transcription

1 Mortgage Payment Protection Insurance Compass Underwriting Limited 40 Lime Street London EC3M 7AW Phone Fax Web Site Effective

2 Mortgage payment protection insurance You have applied for mortgage payment protection insurance with AXA Insurance UK plc. In return for the appropriate premium, this insurance will cover you against disability or unemployment (or both), in line with the conditions and exclusions in this policy. This policy, your proposal and any endorsements, together with the summary of cover, key features and certificate of insurance, are part of this insurance contract. 1 Eligibility This insurance is not valid unless your certificate of insurance is attached You are eligible for this insurance as long as at the start date you: permanently live in the United Kingdom, Channel Islands or Isle of Man; are aged between 18 and 64; are working in employment or self-employment and you have been so continuously for the previous six months, during which time you have not been registered as unemployed with the appropriate government agency; and have a mortgage to protect. Important notes If, at the start date, you know that you will become unemployed, we will not pay any claim for that period of unemployment (please see section 5a Circumstances when you cannot claim for full details). If you are made unemployed, or are notified that you will be, within the exclusion period, you will not be able to claim for that period of unemployment (please see section 5a Circumstances when you cannot claim for full details). If, at the start date, you are on a fixed-term contract, please see the definition of regular fixed-term contract, section 4b Unemployment benefit and section 5a Circumstances when you cannot claim for full details of how you will be treated by this policy and how you will be treated during a claim. If, at the start date, you are a company director, a company secretary or you are a relative of a director who is working for the same company as you, please see section 4b Unemployment benefit for full details of how you will be treated by this policy and how you will be treated during a claim.2. Definitions 2 Definitions Where we explain what a word means, that word will have the same meaning wherever it is used in the policy or certificate of insurance. These words are highlighted in bold. Amendment date Benefit period Business Carer Ceased to trade Certificate of insurance Chronic condition College Company director The date any amendment to the cover shown on your certificate of insurance comes into force. The maximum number of monthly benefit payments that we would pay for any one claim, as shown on your certificate of insurance. A trade, industry or profession you own and run either alone or in association with others and which is registered in the United Kingdom. You having to care for a member of your immediate family and receiving a carer s allowance from the relevant government department. You are entirely out of paid work because your business has failed or the business of which you are a controlling director has failed, and you have provided accounts to your last day of trading and your last tax return has been placed with your local tax office. This does not include a temporary break in the trading of the business. The document which sets out the insurance cover we provide under the conditions of this wording. Any medical condition, injury, illness, disease, sickness or related condition that has at least one of the following characteristics. Continues indefinitely Is constant and controlled rather than cured Has symptoms that keep coming back and have needed consultation, treatment, advice or care in the past Needs long-term monitoring, treatment, consultation, check-ups, examination or tests The Royal College of Surgeons, the Royal College of Physicians or any of the Royal College of Medical Practitioners. A director who owns more than 10% of the issued share capital of the company (or you are a relative of a director who is working for the same company as you and who owns more than 10% of the issued share capital of that company).

3 Consultant Deferred period Disability Disabled Doctor Employed Employment Exclusion period Gross income Monthly benefit Mortgage Normal pregnancy and childbirth-related conditions Notified Period of cover Pre-existing conditions Premium A medical specialist who is a member of a college and recognised by that college to be a consultant. The number of days in a row as shown in your certificate of insurance during which you will need to be continuously unemployed or disabled before you are entitled to receive the monthly benefit. No benefit will be paid for this period. An accident or sickness certified by a doctor in the UK which prevents you from doing your normal work or any similar work for which you are reasonably qualified and you are not doing any other job for payment or reward. You are suffering from a disability. A qualified UK-registered medical practitioner registered with the General Medical Council, practising in the UK. If you or a relative are a doctor, you or they cannot confirm your disability during a claim. In employment. You are actively working for payment under a permanent contract of employment or a regular fixed-term contract of at least 16 hours a week and paying class-1 National Insurance contributions. The period starting on the start date and lasting for the number of days shown on your certificate of insurance. Any unemployment that you are notified of or which happens within this period is not covered. There is no exclusion period for disability claims. Your monthly salary before tax and National Insurance have been taken off, plus the average of any overtime, commission or bonus payments you have received in the 12 months before the start date. The amount of cover you have chosen, as shown on your certificate of insurance, which represents the following. a The mortgage interest payments or mortgage interest and capital payments (not including arrears and underpayments), as long as you have paid the premiums to cover this and we have accepted them. And, if you choose: b An extra amount towards the following, as long as you have paid the premiums to cover these items and we have accepted them. The insurance premium for this policy Buildings and contents insurance premiums (or both) Other related expenses (for example, household bills and life-assurance premiums) The most we will pay under part b of the monthly benefit will not be more than 100% of part a if the start date of this insurance is within 30 days of your new mortgage being completed or 50% of part a if the start date of this insurance is at any other time. The maximum monthly benefit we will pay in total will not be more than 1,500 or 66% of your gross income, whichever is lower. If you need joint cover, you are both entitled to choose a proportionate share, usually relative to your incomes, of the monthly benefit. Important note: You should be aware that any benefit from this policy which is not used to pay the monthly mortgage repayments, the buildings insurance premium or the premium for this policy may be considered by the appropriate government agency as income and may affect the amount of the state benefit you receive. The agreement between you and a mortgage lender that sets out the terms of the finance arranged over your main home, which is not in arrears. Any symptoms which normally accompany a pregnancy or childbirth (including those related to a pregnancy with more than one baby) and which do not represent an unusual or significant danger to mother or baby. Being told or given notice that you are specifically at risk of being made unemployed. A period of one month from the start date, and each later month for which the premium is received and accepted by us, until cover ends as described in section 6. Any medical condition, injury, illness, disease, sickness or related medical condition, and associated symptoms, whether diagnosed or not, which you: a knew about or should reasonably have known about at the start date; or b have seen or arranged to see a doctor about during the 12 months immediately before the start date; and which comes back within 24 months after the start date. The amount set out in your certificate of insurance which you pay each month in return for cover under this policy. Regular fixed-term contract A contract of at least 12 months with the same employer that has been renewed at least once, or a contract with the same employer for a continuous period of at least 24 months or a fixed-term contract to which you were transferred from a permanent contract of employment with the same employer with no break between contracts. Relative A husband, wife, partner or any other immediate family member related to you by blood, marriage or law. Self-employed or self-employment You are in a profession or business alone or with others and paying class-2 National Insurance contributions, or you are a company director. Start date The date the insurance begins, as shown on your certificate of insurance. The insurer AXA Insurance UK plc, registered in England number 78950, with a registered office at 107 Cheapside, London EC2V 6DU. Unemployed or unemployment A period during which you must be no longer employed or self-employed and be: a receiving the appropriate class of National Insurance contribution credits; b available for and actively looking for work in the UK; c registered as unemployed with the appropriate government agency; d entirely without work; and e not receiving wages. If you are self-employed, in addition to a to e above you must also have ceased to trade. If you are a company director, your company must have been wound up by a creditor who is not a director of that company. Waiting period The number of days in a row as shown in your certificate of insurance during which you will need to be continuously unemployed or disabled before you will be entitled to receive your first monthly benefit payment. We, us, our Compass Underwriting Limited on behalf of the insurer. You or your The person or people named on your certificate of insurance. 3 Paying premiums a If you are paying for your cover each month by direct debit (as shown in the certificate of insurance), you must provide bank details and we will collect debits each month. This insurance will automatically end if any payment is not made and you fail to put this right within 14 days. b If you are receiving monthly benefit under this insurance, you must continue to pay the premium as it falls due. c We or the insurer can change the premium by giving you 30 days notice in writing. If there are any changes to the current level of Insurance Premium Tax (IPT), or any new charges are placed on us or the insurer, we will change your premium from the date any changes are put in place. 4 Paying claims You must keep to the following conditions to have the full protection of your policy. If you do not, we or the insurer may cancel the policy, refuse your claim or reduce the amount of any claim payment. A Disability benefit This cover only applies if your certificate of insurance shows that you have chosen disability cover benefit. If your certificate of insurance shows that you have a deferred period, the following applies. If you are in continuous employment and become disabled during the period of cover for longer than the deferred period, we will pay you 1/30 of the monthly benefit for each day you are continuously disabled after the deferred period. We will pay the benefit every month for the month passed, up to the maximum benefit period shown in your certificate of insurance. As long as we have all the information we ask for to validate your claim, the first monthly benefit payment will be made 31 days after the deferred period ends. If your certificate of insurance shows that you have chosen a waiting period, the following applies. If you are in continuous employment and become disabled during the period of cover for longer than the waiting period, we will pay you a monthly benefit payment on the day after the waiting period has ended as long as we have all the information we need to validate your claim. We will continue to pay 1/30 of the monthly benefit for each further day you remain continuously disabled. We will pay the benefit every month for the month passed up to the maximum benefit period shown in your certificate of insurance.

4 The following applies to all policies. We will continue to pay you until: 1 the last day of your disability; 2 the date you stop providing proof that you are still disabled; 3 we have made the maximum number of monthly benefit payments in the benefit period; 4 you return to work; or 5 cover ends as described in section 6; whichever happens first. B Unemployment benefit This cover only applies if your certificate of insurance shows that you have chosen unemployment cover benefit. If your certificate of insurance shows that you have chosen a deferred period, the following applies. If you are in continuous employment and become unemployed during the period of cover for longer than the deferred period, we will pay you 1/30 of the monthly benefit for each day you are continuously unemployed after the deferred period. We will pay the benefit every month for the month passed, up to the maximum benefit period shown in your certificate of insurance. As long as we have all the information we ask for to validate your claim, the first monthly benefit payment will be made 31 days after the deferred period ends. We may ask you to see one of our appointed consultants to help you look for permanent work. If your certificate of insurance shows that you have chosen a waiting period, the following applies. If you are in continuous employment and become unemployed during the period of cover for longer than the waiting period, we will pay you a monthly benefit payment on the day after the waiting period had ended as long as we have all the information we need to validate your claim. We will continue to pay 1/30 of the monthly benefit for each further day you remain continuously unemployed. We will pay the benefit every month for the month passed up to the maximum benefit period shown in your certificate of insurance. We may ask you to see one of our appointed consultants to help you look for permanent work. The following applies to all policies. We will continue to pay you until: 1 the last day of your unemployment; 2 the date you stop providing proof that you are still unemployed; 3 we have made the maximum number of monthly benefit payments we allow in the benefit period; 4 you return to work; or 5 cover ends as described in section 6; whichever happens first. Unemployment cover under this certificate of insurance will depend on your employment status. Employed people (not including company directors, company secretaries or their relatives if working for the same company or contract workers) a If you are working, and you are eligible to claim under this policy, we will cover you if you become unemployed. Employed company directors, company secretaries or their relatives a If you own less than 10% of the issued share capital of the business you are working for, or you are a relative of a company director or company secretary who owns less than 10% of the issued share capital of the business you are working for, and you are eligible to claim under this policy, we will cover you if you become unemployed. b If you own more than 10% of the issued share capital of the business you are working for, or you are a relative of a company director or company secretary who owns more than 10% of the issued share capital of the business you are working for, and you are eligible to claim under this policy, we will cover you if that business ceased to trade. b If you have been working on a renewable fixed-term contract which does not meet the definition of a regular fixed-term contract, and you are eligible to claim under this policy, we will cover you if you become unemployed during the term of your contract. We will not cover you if your contract is not renewed, and any entitlement to monthly benefit under this insurance will automatically end on the date your contract was originally going to finish. Self-employed people and their relatives If you are the sole owner or a partner in the business you are working for, or you are a relative of the sole owner or partner in the business you are working for, and you are eligible to claim under this policy, we will cover you if that business ceased to trade. C Claiming more than once Disability claims If we have paid the maximum number of monthly benefit payments in the benefit period for any one disability claim, you must have returned to work for at least: six months before you will be entitled to claim again for the same disability; one month before you will be entitled to claim again for a different unrelated disability; or one month before you are able to claim for unemployment. If we have paid less than the maximum benefit period for any one disability claim, you must have returned to work for at least one month before you can claim again for a different unrelated disability. If you suffer the same disability again within three months of returning to work, we will treat your claim as a continuation of the original claim. The deferred period or waiting period will not be re-applied, and in total we will pay monthly benefit payments up to the maximum benefit period. Unemployment claims If we have paid the maximum number of monthly benefit payments in the benefit period in respect of any one unemployment claim, you must have returned to work for at least: six months before you are able to claim again for unemployment; or one month before you are able to claim for a disability. If there are less than six continuous months of employment or other work between two periods of unemployment, we will treat these two periods as one continuous claim. We will not pay any monthly benefit payments for the time you were in employment or other work between the two periods of unemployment. In total, we will pay monthly benefit payments up to the maximum benefit period. If your claim changes from unemployment to disability or from disability to unemployment, the deferred period or waiting period will not be re-applied, and in total we will pay monthly benefit payments up to the maximum benefit period. D Suspending an unemployment claim for temporary work If you are eligible to claim for unemployment under this insurance and you are offered a temporary job, you can suspend your claim as long as: 1 you tell us who you will be working for (even if you will be self-employed), how many hours you will be working for and how long the temporary work will last; 2 your temporary job lasts for at least one week and no longer than six months, and you do not have more than three separate jobs during any one claim; and 3 you continue to meet the conditions of this insurance and tell us immediately if any of the circumstances above change. You are eligible to claim for unemployment when a temporary job ends as long as you have kept to the above conditions. We will begin paying you monthly benefit payments again (up to your chosen benefit period for any one claim). Employed contract workers a If you have been working on a regular fixed-term contract, and you are eligible to claim under this policy, we will cover you if you become unemployed.

5 5 Circumstances when you cannot claim A Unemployment We will not pay the monthly benefit for any unemployment if: You are notified about the risk of unemployment within the initial exclusion period, even though your unemployment may not take place until after this period. It follows a period of casual, temporary or occasional work. Your work is seasonal and unemployment is a normal part of it, or unemployment is a regular feature of your work. You are unemployed during a period in which you have received payment instead of working your notice. If it is unclear what period is covered by this payment, we will work out the period in weeks by dividing the amount of the payment by your average gross earnings each week for the 13 weeks immediately before your unemployment started. It arises as a result of you coming to the end of a fixed-term contract or a contract for your services, unless it is a regular-fixed term contract. It is caused by your resignation, voluntary unemployment or voluntary redundancy. This exclusion will not apply if: a your unemployment is solely and directly as a result of you becoming a carer, and you can provide evidence to us which proves that you were not aware at the start date that you would become a carer; or b your voluntary redundancy is claimed under section 147 of the 1996 Employment Rights Act due to short-time working. If you make a claim, you will have to produce documentation to confirm that your redundancy is within the terms of this Act. Youare dismissed by your employer because of: a your own misconduct; b you breaking a condition of your contract; c industrial action in which you are involved; or d failing to meet the standards or targets set by your employer. Youknew about the possibility of unemployment (or in our reasonable opinion you should have known about it) at the start date. Youare self-employed and cannot provide satisfactory evidence of having ceased to trade. You refuse any offer of reasonable alternative employment by your employer. B Disability We will not pay monthly benefit if your disability: results from you deliberately injuring yourself; is caused by alcohol, solvent abuse or drugs (other than drugs taken under the direction of a doctor or consultant and not to treat drug addiction); arises from stress, anxiety or depression, or any mental or nervous disorder, unless investigated and diagnosed by a consultant specialising in the relevant field; results from a pre-existing condition; results from a chronic condition that you knew about or should reasonably have known about at the start date, whether it needed medical attention at that time or not; is caused by normal pregnancy and childbirth-related conditions (when you make a claim for a pregnancy or childbirth-related condition, we may refer to a doctor who specialises in obstetrics for an opinion as to whether the condition is a normal pregnancy and childbirth-related condition this opinion will be final); is due to a back complaint or related condition, unless supported by specialist medical evidence; C For unemployment and disability sections We will not pay monthly benefit for any disability or unemployment: arising directly or indirectly from war, revolution, riot or any similar event; arising from radioactive contamination from ionising radiation or contamination from any nuclear fuel, or from any nuclear waste arising from burning nuclear fuel, or the radioactive, toxic, explosive or other dangerous effect of any explosive nuclear equipment or part of that equipment; resulting from any criminal or fraudulent acts in which you are involved; that happens after you reach age 65 (or reach your normal retirement date if earlier); that happens while you are away from the UK, Channel Islands or Isle of Man for a period intended by you to be of more than 90 days in a row. This exclusion will not apply if your reason for leaving the UK, Channel Islands or Isle of Man is because you: a work for the British Armed Forces; or b work as a civil servant in a British embassy or consulate. You cannot claim disability and unemployment benefit at the same time. 6 Ending the insurance Your insurance will end on whichever of the following happens first: a The date you reach 65. b The date you reach your normal retirement date. c The date your mortgage ends. d The date on which your circumstances change if the change would make the insurance invalid. e The date the premium is due in the event of the premium not being paid by you and you failing to put this right within 14 days. f Your death. g You tell us in writing that you want to cancel this policy and return your certificate of insurance. We will cancel the insurance on the day we receive your request. If you cancel this insurance within 14 days of the start date, we will refund any premium you may have paid unless you have made a claim. h We or the insurer give you 90 days notice in writing, if we are not going to offer you a substitute scheme, of the policy being cancelled (or 30 days notice in writing if we are offering you cover under an alternative policy). i We or the insurer refuse to continue to provide cover after giving you notice, in writing, of our refusal. 7 Fraud You must not act in a fraudulent way. If you or anyone acting for you: make a claim under the policy knowing the claim to be false or exaggerated in any way; or make a statement in support of a claim knowing the statement to be false in any way; or send us a document in support of a claim knowing the document to be forged or false in any way; or make a claim for any loss caused by your deliberate act or with your agreement; then we or the insurer: will not pay the claim; will not pay any other claim which has been or will be made under the policy; may declare the policy void; will be entitled to recover from you the amount of any claim already paid under the policy; will not return any of your premiums; may let the police know about the circumstances. arises from medical operations or treatments which are not medically necessary to maintain your quality of life and which are carried out at your request; results from attempted suicide or wilful exposure to danger (except in an attempt to save human life); or is not supported by medical evidence from a doctor.

6 8 General conditions You must keep to the following conditions to have the full protection of your policy. If you do not, we or the insurer may cancel the policy, refuse your claim or reduce the amount of any claim payment. a This policy and any endorsements, together with the proposal form, summary of cover, key features and certificate of insurance, make up the contract between you and the insurer. b This contract or any of the conditions of this contract cannot be changed unless this is done in writing by one or more of our authorised officials. If in doubt, please contact your intermediary who arranged this insurance. c You must, within 14 days of the end of each monthly period or as soon as reasonably possible, give your intermediary notice in writing of any change in your personal circumstances. This includes changing your employer, occupation, state of health, living or working outside the UK, changing from being employed to self-employed (or vice versa), working less than 16 hours each week, or any other relevant circumstance. (If you are not sure whether to tell your intermediary, please write to them anyway.) d You and we are free to choose the law which applies to this insurance contract. Unless you and we agree otherwise, this insurance will be governed by English law and the English courts will deal with any disputes. e If any condition of this contract becomes invalid or illegal, or cannot be enforced, it will not affect the rest of the contract. f All benefits under this insurance will not be taxed, although this may change in line with any amendments to legislation. If this happens, we will take from any monthly benefit any amounts which, by law, we have to take. g If you miss out any important information or provide false statements in your application for this insurance or any claim, we may not pay benefits under this insurance. Important information is information which is likely to influence whether we accept your application or claim for insurance. If you are not certain whether a fact is important, you should tell us anyway. If you make a claim which we consider to be fraudulent or exaggerated, you will lose all benefits under this contract and we will try to recover any benefits we have paid under that claim. h To set up and administer your policy, AXA Insurance UK plc and Compass Underwriting Limited will hold and use information about you supplied by you and by medical providers. We may send it in confidence for processing to other companies in the AXA Group (or companies acting on our instructions), including those outside the European Economic Area. By buying this insurance, you are agreeing to us using your personal data in this way. 9 Increases to the monthly benefit or change in insurance cover The monthly benefit and the insurance cover shown on your certificate of insurance will remain unchanged unless you contact us and we agree to a variation. You cannot increase the amount of monthly benefit or change the insurance cover while you are making a claim. Please note that unless an increase to the monthly benefit is as a direct result of an increase in the mortgage interest rate that applies to your mortgage, as supported by evidence from your lender, a 90-day qualifying period will apply to the increase starting on the amendment date. So, if you are notified that you are going to be made unemployed within the 90-day period, you will receive only the original monthly benefit and we will not pay the increased benefit during the claim. This 90-day qualifying period will also apply if the policy is in joint names and the monthly benefit is transferred between the people who are insured. 10 How to claim A All claims You must write to us about a claim within 30 days of being notified of your unemployment or becoming disabled, or as soon as reasonably possible. Write to our claims department at Compass Underwriting Limited, 40 Lime Street, London, EC3M 7AW, phone our customer service desk on or go to to get a claim form. We will send you the claim form. You will need to fill this in and return it to us as soon as reasonably possible, giving us all the information we ask for so we can process your claim. If you delay in sending in a claim to us, it may make your claim harder to confirm. It could also lead to a delay in paying your claim or not paying your claim at all. B Unemployment claims In support of any unemployment claim, the evidence you provide should include wage slips, your termination notice and your P60. If you are self-employed, it should include a bank statement, invoices, annual accounts, and Inland Revenue and National Insurance records. You must keep a detailed job-search diary, including all related documents and supporting evidence. If, during an unemployment claim, you decide to look for work in another member state of the European Union, we will continue to deal with your claim for up to three months as long as you have made arrangements with the relevant government agency to register as unemployed in the country you are going to and provide us with a copy of your E303/3 form, together with evidence of your continued unemployment. C Disability claims You must allow us access to your medical records as defined by the Access to Medical Reports Act And, if we want you to have a medical, you must have one or we may refuse to pay your claim. We will pay any costs involved for the medical. 11 Complaints procedure We always try to provide a first-class standard of service. However, if you have any question or complaint, either about your insurance or about a claim, you should first contact the intermediary who arranged this insurance for you. If you are still not happy, please write to: The Managing Director Compass Underwriting Limited 40 Lime Street London EC3M 7AW. You can fax or us at complaints@compassuw.co.uk. You need to clearly give the reason for your complaint. Please also make sure that you give us all your contact details and your policy or claim number. If we cannot sort your complaint out or you are still not satisfied, you can take the issue further. You will need to write to: The Head of Customer Care AXA Insurance UK plc Civic Drive Ipswich IP1 2AN. Phone , fax or customercare@axa-insurance.co.uk who will arrange for an investigation on behalf of AXA Insurance s Chief Executive. If the insurer has given you their final response and you are still not satisfied, you may refer your case to the Financial Ombudsman Service (FOS) at: Financial Ombudsman Service Insurance Division South Quay Plaza 183 Marsh Wall London E14 9SR. Phone or fax The FOS is an independent organisation that arbitrates on complaints about general insurance products. It will consider complaints after the insurer has given you written confirmation that they have been through their full complaints procedure. You have six months from the date of the insurer s final response in which to refer your complaint to the FOS. This does not affect your right to take legal action. AXA Insurance UK plc is authorised and regulated by the Financial Services Authority. This can be checked on the FSA s register by visiting the FSA s website at or by contacting them on If necessary, you must meet our appointed representative, consultant or adjuster. We will pay the monthly benefit when we receive satisfactory evidence of your entitlement to claim. Throughout any claim, we will need you to provide evidence of your disability or unemployment by filling in a monthly continuation claim form. We will not pay monthly benefit for any period of disability or unemployment for which you do not provide evidence.